Medical

Please refer to the sections located near the bottom of this page for the Tobacco-Use and Working Spouse Surcharge FAQs and instructions on how to submit your surcharge status.

Questions to Ask

Choosing a medical plan option is one of the most important decisions for you and your family. When selecting a medical plan, you should ask yourself several questions and carefully consider each answer:

The SCL Health medical plans are “Point of Service” plans. Each provider network tier has a different arrangement for sharing costs. You and your covered family members choose which tier to use each time you seek care.

At SCL Health, we are in the healthcare business. That allows us to offer our associates both exceptional care and the opportunity to control costs. All three medical plan options offer the highest level of benefits when you use SCL Health Network (Tier 1) providers and facilities. To enjoy all these cost savings, you first need to know which hospitals and doctors are in the SCL Health Network and which ones are not, as shown in the Plan Networks Chart.

Reminder:You can access custom provider directories created specifically for SCL Health under the "Custom Provider Directory - Search for Tier 1 Options" section on this page.

Health Reimbursement Account (HRA) — For those who elect the CDHP medical plan, SCL Health funds a Health Reimbursement Account (HRA) for you to use to cover initial out-of-pocket expenses. Your initial out-of-pocket expenses are paid from the HRA. Once the money in your HRA is exhausted, you pay medical and pharmacy expenses until you reach the annual deductible.

Deductible — The Consumer Driven Health Plan (CDHP) option has a deductible that you must meet before the plan begins to pay coinsurance. The deductible does apply to your out-of-pocket maximum.

Out-of-Pocket Maximum — The out-of-pocket maximum is the most you will pay out-of-pocket during the plan year. Once you reach the out-of-pocket maximum, the plan pays 100% of your eligible medical and pharmacy expenses for the rest of the plan year.

Deductible — Cigna PPO option has a deductible that you must meet before the plan begins to pay coinsurance. The deductible does apply to your out-of-pocket maximum

Out-of-Pocket Maximum — The out-of-pocket maximum is the most you will pay out-of-pocket during the plan year. Once you reach the out-of-pocket maximum, the plan pays 100% of your eligible medical and pharmacy expenses for the rest of the plan year.

Reminder— If you elected to contribute to a Health Care Flexible Spending Account (FSA), you can use your FSA to pay for eligible out-of-pocket expenses, such as annual deductible, coinsurance and copay responsibility.

Deductible — The Kaiser EPO medical plan option has a deductible that you must meet before the plan begins to pay coinsurance. The deductible does apply to your out-of-pocket maximum.

Out-of-Pocket Maximum — The out-of-pocket maximum is the most you will pay out-of-pocket during the plan year. Once you reach the out-of-pocket maximum, the plan pays 100% of your eligible medical and pharmacy expenses for the rest of the plan year.

Reminder— If you elected to contribute to a Health Care Flexible Spending Account (FSA), you can use your FSA to pay for eligible out-of-pocket expenses, such as annual deductible, copays and coinsurance responsibility.

Tobacco products are defined as tobacco or tobacco-like products intended for human consumption, and when used orally or inhaled, produce smoke or smoke-like vapor. This includes but is not limited to: cigarettes, cigars, loose tobacco smoked via pipe or hookah, chewing tobacco, snuff, dip, electronic cigarettes and vaporizers.

If you are enrolling in a 2017 SCL Health medical plan:

SCL Health will apply a tobacco surcharge of $50 per month if you and/or any of your covered adult dependents use tobacco products or have used tobacco products within the last six months.

If you are enrolling in a 2018 SCL Health medical plan:

If there is only one adult covered on the medical plan who currently uses or has used tobacco products within the last six months, you will be charged $50 per month.

There are two or more adults covered on the medical plan who currently use or have used tobacco products within the last six months, you will be charged $100 per month.

The surcharge will not apply if each covered adult tobacco-user satisfies one of the following:

He or she completes the SCL Health QuitLine Program or an onsite SCL Health tobacco cessation program within the six-month period ending on the date you submit your tobacco-use status; or

His or her personal physician attests that it is medically inadvisable for their patient to attempt to cease tobacco use. Contact the HR Service Center for a copy of the Physician Affidavit.

Action Required

If you are enrolled in or plan to enroll in a medical plan, you must certify if the surcharge applies to you by submitting your tobacco-use status through your enrollment process. Click here for screenshots to help walk you through the designation process in Lawson ESS during Open Enrollment.

If the tobacco-use status of any adult covered member of your medical plan changes mid-year, you must re-submit your tobacco surcharge status so the surcharge can be adjusted as necessary. To re-attest your tobacco surcharge status complete the below Affidavit form and submit to the HR Service Center.

SCL Health encourages associates and their working spouses to evaluate all medical plan options before enrolling in SCL Health’s plan to ensure they are enrolling in the most affordable plan available to them. If your spouse has access to medical coverage through his or her employer, but waives that coverage and instead enrolls in an SCL Health medical plan, a $100 monthly surcharge will apply. This surcharge will be collected on a pre-tax basis through payroll deductions.

The surcharge will not apply if your spouse:

Only has access to employer-provided medical coverage with an annual in-network out-of-pocket maximum greater than $5,000 for associate-only coverage and $10,000 if covering dependents; or

Is enrolled in his or her employer’s plan and an SCL Health plan as secondary coverage; or

Is enrolled in Medicare, Medicaid, Tricare or Tribal health insurance as his or her only other coverage; or

Is an SCL Health benefits-eligible associate.

Action Required

If you cover your spouse on your SCL Health medical plan, you must certify that your spouse does not have access to other coverage through his or her own employer to avoid the $100 monthly working spouse surcharge. Click here for screenshots to help walk you through the designation process in Lawson ESS during Open Enrollment.

Moving forward, you will be required to re-certify each year that your spouse does not have access to other coverage through his or her own employer.

If your spouse gains or loses employer coverage mid-year, you must re-submit the Working Spouse Affidavit through the Qualify Life Event Form so the surcharge can be adjusted as necessary.

The Summary Plan Description, or SPD, communicates plan rights and obligations to participants and beneficiaries. This is a summary of the material provisions of the plan document. Click here to locate Medical SPDs.

Our facilities do not discriminate against any person on the basis of race, color, national origin, disability, or age in admission or access to, or treatment or employment in, its programs, services or activities, or on the basis of sex (gender) in health programs and activities. Read the full notice: